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Let’s Look At The Most Common 1095-C Coverage Scenarios

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Estimated reading time: 7 min

KB14-087

Please review the most common coverage scenarios below.

Full-Time Employee: Enrolled All Year

In this example, the employee was offered & enrolled in a minimum essential coverage with minimum value for all twelve months AND the lowest-cost, self-only plan cost increased in the month of June due to it being a mid-year plan.

  • Line 14- Code 1E is used in this example because MEC coverage providing MV was offered to the employee, spouse & dependents.
  • Line 15- Should show the employee share of the monthly cost for the lowest-cost, self-only coverage.
  • Line 16- Code 2C should be used because the employee elected coverage.

Full-Time Employee: Waived Coverage All Year

In this example, the employee was offered coverage at the beginning of the plan year (i.e. January) and chose to waive the offer of coverage.

  • Line 14- Code 1E is used in this example because MEC coverage providing MV was offered to the employee & their spouse/dependents.
  • Line 15- Although the employee waived coverage in this example, the employees’ monthly share of the lowest-cost self-only coverage offered still must be populated.
  • Line 16- Code 2F is used because the employee waived coverage and the employer is using the W-2 safe harbor to determine plan affordability.

Newly Hired Designated Full-time Employee: Waiting Period Applies

In this example, the full-time employee, reasonable expected to work more than 30 hours per week, was hired on May 5th and is eligible for coverage first of the month following date of hire (i.e. June 1st). The employee chose to enroll herself & dependents in the self-funded plan.

  • Line 14- Code 1H (No Offer of Coverage) is used for the months the employee was not employed. Code 1E is used during the months that the employee became eligible for coverage & MEC coverage providing MV was offered to the employee, spouse & dependents.
  • Line 15- The employees’ monthly share of the lowest-cost self-only coverage offered only needs to be populated for the months the employee was eligible for coverage.
  • Line 16- Code 2A is used for the months the empl